After years of being a central political question, health care is on the back burner. Both parties contain experts and activists who want to make major changes to health policy. But for now, both parties’ politicians are wary. Democrats are, as usual, more interested in the subject than Republicans, but they are somewhat divided about what to do next and in any case are not yet in a position to enact anything. Republican politicians, meanwhile, seem to have concluded from their failed efforts to repeal and replace Obamacare that the whole issue is best avoided. It is not surprising, then, that talk of a bipartisan deal to shore up Obamacare’s insurance exchanges has petered out.

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It’s the pragmatists versus the idealists in California’s latest quest for universal health care. Increasing numbers of lawmakers and advocates are pushing for policy goals that realistically can be accomplished this year. But there’s an unrelenting camp clinging to single-payer-or-bust.

The Golden State, which has been pushing back against the Trump administration on multiple fronts, is leaning toward the more incremental approach. This includes bills and budget items that would cover everything from insuring undocumented adults to preventing Medicaid work requirements and shielding the state from insurance products favored by the GOP, such as short-term plans.

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California is indeed the Golden State where Medicaid is concerned. The HHS Office of Inspector General (OIG) has found that, by exploiting Obamacare’s expansion of the program, California has enrolled hundreds of thousands of ineligible adults in Medicaid. Consequently, the state has bilked the federal government out of more than $1 billion in funding to which the state was not entitled. Indeed, these figures probably understate the amount of money that California officials have fraudulently extracted from the taxpayers. The OIG sampled a mere six-month period, from October 1, 2014 through March 31, 2015, to arrive at its damning assessment.

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The Trump administration said on Tuesday that 11.8 million people had signed up for health insurance through the Affordable Care Act marketplaces for 2018 — roughly 400,000 fewer than last year. Virtually the entire decrease came in the 39 states that use the marketplace run by the federal government, HealthCare.gov. In the 11 states that sell coverage for the ACA through their own marketplaces, enrollment remained the same as last year.

Ohio officials asked the Trump Administration on Friday to formally waive the Affordable Care Act individual mandate that requires residents to have health insurance, making it the first state to make such a waiver request.

Ohio’s Legislature called for the 1332 waiver last summer, and Congress zeroed out the financial penalty for not having coverage in its tax bill in December.

“The (tax) legislation zeroed out the penalty that is associated with the individual mandate … but … did not eliminate the mandate itself,” Ohio Department of Insurance Director Jillian Froment said in a March 30 letter to HHS Secretary Alex Azar. “That is why Ohio is submitting an application to waive [the mandate].”

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A new law in Iowa could provide the path forward for Republican-led states that are looking for ways around ObamaCare’s rules and regulations.

Iowa Gov. Kim Reynolds (R) on Monday signed a law that will allow the Iowa Farm Bureau to collaborate with Wellmark Blue Cross Blue Shield on self-funded “health benefit plans.”

The plans would be cheaper than traditional ObamaCare plans because they wouldn’t be required to meet federal requirements.

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Donald Trump’s health secretary was on fire during a March 5 address to the Federation of American Hospitals. Alex Azar, the former Eli Lilly executive now charged with overseeing everything from Medicare to the Centers for Disease Control & Prevention, outlined plans to achieve nothing less than the “value-based transformation” of American health care.

“Today’s healthcare system is simply not delivering outcomes commensurate with its cost,” he said. And Azar put his biggest finger on a commonly blamed problem: the fact that American health care is “paying for procedures and sickness” instead of “outcomes and wellness.”

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New health-insurance legislation in Iowa will become the latest test of the ability of states to allow coverage that doesn’t comply with the federal Affordable Care Act.

Iowa Gov. Kim Reynolds is expected to soon sign into law a bill that would allow the Iowa Farm Bureau, a nonprofit, to offer health coverage that would fall outside the ACA’s rules. The new coverage, which the legislation calls “health benefit plans,” would be administered by the state’s largest insurer, Wellmark Blue Cross & Blue Shield . The product would officially not be considered health insurance, according to the legislation—leaving details of the coverage unclear.

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More Democrats than ever have signed on to a proposal that would shift every U.S. resident onto Medicare, but a large proportion remain uncertain about heading into a completely government-run system as an immediate sequel to Obamacare.

The Medicare for All Act that has been introduced would move everyone in the U.S. onto Medicare, even if they have private healthcare coverage. It is backed by Sen. Bernie Sanders, I-Vt., and an unprecedented 16 Democratic senators. Among them are possible 2020 presidential hopefuls Sens. Cory Booker, D-N.J., Kamala Harris, D-Calif., Elizabeth Warren, D-Mass., and Kirsten Gillibrand, D-N.Y. Most Democratic lawmakers in the House have co-sponsored a similar bill.

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The Iowa Senate gave final approval Tuesday to controversial legislation that would exempt certain health plans from Affordable Care Act mandates.

The legislation combines two proposals backers say would reduce health insurance costs, but critics worry could undermine consumer protections.

Senate File 2349 was approved 37-11, sending it to Gov. Kim Reynolds, whose spokeswoman said she was “eager” to sign it. The measure passed the House last week.

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